Book Review: The handbook of Clinical Gerontology
Identifieur interne : 000006 ( Istex/Corpus ); précédent : 000005; suivant : 000007Book Review: The handbook of Clinical Gerontology
Auteurs : Sigrun-Heide FilippSource :
- International Journal of Behavioral Development [ 0165-0254 ] ; 1992-12.
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DOI: 10.1177/016502549201500407
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URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="review-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">spjbd</journal-id><journal-id journal-id-type="publisher-id">JBD</journal-id><journal-title>International Journal of Behavioral Development</journal-title><issn pub-type="ppub">0165-0254</issn><publisher><publisher-name>Sage Publications</publisher-name><publisher-loc>Sage CA: Thousand Oaks, CA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/016502549201500407</article-id><article-id pub-id-type="publisher-id">10.1177_016502549201500407</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Book Review: The handbook of Clinical Gerontology</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Filipp</surname><given-names>Sigrun-Heide</given-names></name><aff>Fachbereich I — Psychologie, Universitat Trier, Germany</aff></contrib></contrib-group><pub-date pub-type="ppub"><month>12</month><year>1992</year></pub-date><volume>15</volume><issue>4</issue><fpage>555</fpage><lpage>561</lpage><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Reviews</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT, 1992,15 (4), 555-561 Book Reviews Carstensen, Laura L. & Edelstein, Barry A. (Eds). (1987). The handbook of clinical gerontology. New York: Pergamon Press. ISBN 0-08-031947-5, 436pp, $95.00. This book presents a wide-range overview of psychologically relevant aspects of somatic and mental illnesses in old age. The main focus of this compendium is on psychiatric disorders, bodily diseases, and related medical problems, as well as on behavioural problems commonly faced in old age. In many cases, in-depth analyses of these various phenomena are presented, and modes of psychological inter-vention are considered. This mainly illness-centred perspective is supplemented by chapters on normal ageing as well as chapters on the social aspects of becoming old. The first part of the book is dedicated to "normal ageing" and deals with the issue of normal ageing from three different perspectives: (1) the molecular perspective with special reference to cell biology; (2) the molar perspective with reference to psychological and physiological changes in the elderly; and (3) the environmental perspective. Hayflick raises the issue of the immortality of cells, presents various theories of biological ageing, and discusses the controversies between their proponents. Zarit and Zarit comment on the widespread prejudices relat- ing to physiological and psychological ageing. They offer a comprehensive overview of the empirical evidence related to the various ageing pheno- mena and discuss the various methodological problems inherent in the study of ageing. Lawton conceptualises the interplay between environmen- tal resources and demands, on the one hand, and the elderly's personal competencies and needs on the other. Based on his model, he discusses several ways to conceptualise services for the elderly by taking the dialec- tics of autonomy and support into consideration. The second part of the handbook deals with psychiatric disorders: mental health problems, typical of the older age, are described and various ways of treatments are discussed. Particular reference is given to paranoid and schizophrenic disorders, alcohol abuse, sexual problems, affective disorders, and dementia, as well as depression. © 1992 The International Society for the Study of Behavioral Development 556 BOOK REVIEWS The chapter by Post focuses particularly on paranoid disorders due to their higher incidence in the elderly, whereas the relationship between schizophrenic and paranoid disorders is mentioned only briefly. Surpris- ingly, the author does not refer to the common classification system as the chapter is presented, for example, DSM-III is not used. The part of Post's presentation refers to his own investigations, the results of which-despite the fact that a control group was not included-are quite instructive with regard to how to manage and treat paraphrenics. The chapter on alcohol abuse, by Zimberg, is highly informative as the author refers specifically to elderly alcoholics and those factors which might contribute to alcohol abuse in the later years of life. In addition, he presents various techniques for the treatment of elderly alcoholics and discusses how to establish effective service networks for the elderly in order to prevent alcoholism. The issue of sexual behaviour and problems of the elderly is dealt with in the chapter by O'Donohue. Quite surprisingly, this issue is also subsumed to "psychiatric disorders" although the author resists the various social myths and stereotypes surrounding the sexuality of the elderly which often equate sexuality of the elderly with "abnormal behaviour". Nevertheless, his chapter presents a valuable overview of age-related changes in sexual physiology and sexual arousal in both men and women. The chapter by Gaylord and Zung on affective disorders among the elderly deals with the symptomatology and aetiology of depression, one of the most common psychiatric disorders among the elderly. The various preventive and therapeutic actions are presented in a comprehensive manner. Special attention is given to the problems of diagnosing depress- ion in the elderly. Various theories to explain and/or predict the onset of depression are briefly described, and the issue of prevention and treatment is discussed from a variety of perspectives. This instructive chapter is followed by an equally informative one by Crook dealing with dementia and the various degenerative diseases which underlie it. The issue of how to assess primary degenerative dementia in general is raised, and special consideration is given to Alzheimer's disease for which various criteria for clinical diagnosis are presented and discussed. The fact that diverging perspectives of the relationship between depression and dementia are presented can certainly be considered an advantage of this handbook. Although Gaylord and Zung as well as Crook are using the concept of "pseudodementia", Teri and Reifler in their chapter on depression and dementia plea for a renunciation of this concept in favour of accepting the view that dementia and depression are coexisting dis- orders, in that one disorder does not protect against the other (or vice versa). BOOK REVIEWS 557 Part 3 of the handbook deals with medical problems that are fairly common in old age. Yates and Yancik start with a contribution on cancer in the elderly, presenting an overview of common cancers, their epidemio- logy, and ways of early detection. Special consideration is given to basic principles of cancer management. The chapter by Santinga deals with common cardiovascular diseases from a primarily medical point of view, and Karpman's chapter deals with orthopaedic issues which are among the most common complaints in the elderly. Age-related changes that occur normally in the musculoskeletal system are presented in an instructive and comprehensive manner. This section on common medical problems is supplemented by a chapter on drug use in the geriatric patient by Bressler. The author focuses on the issue that adverse drug reactions in the elderly are often observed and discusses the various factors influencing these reactions. The implications for drug dosing in the elderly are highlighted. Part 4 is dedicated to behavioural problems among the elderly and their management. Special consideration is given to functional disabilities that either stem from physical insult or are seen as reflective of problems grounded in the elderly's social environment. The first chapter in this section by Hussian deals with disorientation and wandering-behaviour which, if not adequately treated, would automatically lead to institutional- isation. Causes for these acute behavioural disturbances, their behavioural signs, as well as potentials for correction are referred to in a very clear presentation, and various ways of treatment for disorientation and wander- ing are briefly discussed. The chapter by Sturgis, Dolce, and Dickerson deals with pain management in the elderly. Following a short overview of the theories and common causes of pain in the elderly, special considera- tion is given to differences between older and younger individuals with regard to pain responsivity. Related problems of the assessment and diagnosis of pain in the elderly as well as intervention strategies are discussed. The authors, finally, present a multimodal approach to the treatment of chronic as well as recurrent acute pain, and they conclude that development techniques particularly suited to the elderly are a high- priority task in the field of behavioural medicine. Baltes and Wahl focus on dependence among elderly and suggest three issues confronting research on dependence, namely, multicausality, multi- dimensionality, and multifunctionality. After a brief overview of epide- miological research findings, the authors' main focus is on theoretical considerations of dependence, in partic-ular the study of dependent behaviour from an operant-learning perspective. Based on a solid body of empirical findings from their own studies, the authors conclude that dependent behaviours are co-determined by environmental conditions, in particular by the presence of social contingencies. Suggestions for correc- 558 BOOK REVIEWS tive, preventive, and optimising interventions, based on their theoretical model and grounded on their findings, are presented. The next chapter by Carstensen deals with age-related changes in social activity. The author briefly comments on the disengagement and activity hypotheses on social activity in old age and claims that systematic research aimed at resolving the theoretical discrepancies has declined sharply over the last decades. Besides these theoretical considerations, particular atten- tion is given to the psychological and physical implications of inactivity. Results from intervention studies designed to increase the rate of social interaction in the elderly are briefly summarised, and underscore the modifiability of social behaviour in old age. Finally, the author presents a life-span theory of social activity as a framework for reconstructing changes in social activity and in accompanying emotional experiences. Social- emotional development is seen as one area in which refinement and maturation continue into very late life. The next chapter by Bootzin and Engle-Friedman deals with sleep disturbances as a frequent complaint amongst older adults. The various causes of sleep disturbances are briefly discussed and non-pharmacological treatments for sleep disturbance are presented in a highly instructive overview. Although evaluation studies are rather scarce, it is concluded that sleep disturbances can be effectively treated not only in younger populations but also in the elderly. The chapter by Burgio and Engel deals with urinary incontinence as a major problem in the elderly which can suffer from being both widely ignored by physicians and often denied by the elderly themselves. The chapter discusses common causes of inconti- nence and describes various approaches to the assessment and treatment of this condition. Special attention is given to behavioural intervention tech- niques which are evaluated as being superior to pharmacological interven- tions or surgery. It is, however, admitted that only few systematic studies have tested these methods in the elderly, although it seems to be clear that incontinence is treatable and should not be seen as a hopeless consequence of the ageing process per se. Another chapter which deals with socially relevant aspects of ageing (besides the Baltes and Wahl chapter on dependence in the elderly) is Patterson's contribution on "Family Management of the Elderly". Given the fact that many elderly people remain firmly embedded in family systems, the necessity to help family members to effectively and satis- fyingly deal with even the impaired elderly in their family is highlighted. This includes a brief discussion on how these various environmental supports, in particular the relative strengths and weaknesses of those who are giving care to the elderly, can be assessed. Various strategies to improve the home environment in such a way that the elderly can maintain socially acceptable and effective social, self-care, and leisure activities are discussed. Three case studies illustrating behavioural techniques to assist BOOK REVIEWS 559 the elderly and their concerned families are presented. In the final chapter in this section, McCaffrey and Fisher deal with the sequelae of cerebrovas- cular accidents and closed head injuries in older people. These are, initially, evaluated within the context of general age-related physiological changes. Cardiovascular accidents are then (due to their relatively higher incidence in the elderly) dealt with from various aspects (epidemiology, recovery, medication, etc.). Closed head injuries are discussed only briefly, mainly in terms of a risk factor in the subsequent development of senile dementia of the Alzheimer's type-although the relationship between the two is still not very well understood. The last part of the handbook, entitled "Social issues", deals with the social context within which the various medical, psychological, and behavioural problems discussed in previous chapters can be viewed. Besides chapters which focus on the ageing individual (social network, critical life events, the quality of home environments etc.), broader societal issues, like the politics of ageing, are also discussed. The chapter by Antonucci and Jackson on "Social support, interpersonal Efficacy, and Health" presents a life-course perspective of the various phenomena related to their topic. Instead of adding another review of the social support literature to the numerous ones that have been published recently, the authors confine themselves to a few introductory comments on critical issues in this literature and to suggesting research steps which could advance the field from its present underdeveloped stage. Next, the evidence on the relationship between social support and health is briefly summarised with special attention given to recent research in the field of psycho-immunology. The main focus is on a model proposed by the authors in which interpersonal support, on the one hand, and perceived control and efficacy, on the other (as well as respective beliefs on the side of the support provider and the support recipient), are represented. Implications of such a framework as well as possible clinical applications are discussed with particular reference to the elderly for whom social support is seen to be of increasing importance. The chapter by Wisocki and Averill on bereavement as a particular problem of the elderly presents a well-structured overview of pathologies associated with bereavement and the conditions that might exacerbate unfavourable consequences. Various behavioural approaches to the prob- lems of the bereaved, i.e. operant and respondent paradigms, are discus- sed, based on the premise that recovery from bereavement involves a good deal of relearning and that the potential for growth is present until death. The chapter on "Prevention of Age-Related Problems" by Kastenbaum as a first step discusses the willingness of gerontologists to readily accept models of prevention and intervention only because they seem to be convenient or intuitively appealing. This is illustrated by referring to reality orientation as a psychosocial programme in day-care institutions as well as 560 BOOK REVIEWS to the life review/reminiscence therapy, both of which are seen to share a lack of evidence stemming from evaluation studies. Because "good inten- tions are not enough", some characteristics of effective prevention prog- rammes are highlighted by the author and are illustrated using examples of various sources. Special attention is given to those preventive strategies which focus on the maintenance and strengthening of interpersonal sup- port for the elderly as well as on efforts to maintain or improve their coping abilities. The chapter by Rowles highlights the importance of the place "to call home" for the elderly. He proposes (illustrated by anecdotal evidence and study findings) that the congruence between personal needs and residential circumstances seems to decrease with age, often resulting in the necessity of residential change in old age. In order to fully understand all aspects of the relocation process and the various experiential costs of a change of residence, research on the relocation process, in general, and on the housing adjustments of the elderly, in particular, is compre-hensively summarised. Suggestions are made in order to ease transitions which involve not only the creation of an attractive environment, but also the provision of support to the old person and his or her family aimed at promoting an ongoing sense of personal continuity. The next chapter by McGadney, Goldberg-Glen, and Pinkston on "Clinical issues for assessment and intervention" is particularly dedicated to the black population within the United States and to the black elderly as a largely under-studied group. After commenting briefly on the implica- tions of ageist and racist attitudes being prevalent across professional disciplines, the experiences of blacks with the medical health care system and other service issues are described. Cultural variations in family struc- ture and environment are discussed as well as life-cycle issues that may be relevant for care-taking behaviour towards the black elderly. Finally, various assessment and intervention strategies are described by using specific single cases for illustration. In the chapter by Kuhn the broader societal perspective on ageing is considered. As a founder and convener of the "Gray Panthers", she presents their perspective on the social system of the United States as well as the prevalent attitudes subsumed to "ageism" in general. Instead of creating a "Gray Lobby" for the elderly, the author argues that it is of greater necessity to respond to the challenges of demographic and tech- nological changes by enhancing the understanding of the initimate connec- tions between private lives and complex societal structures and by forming a basis for effective intergenerational relationships rather than by perpe- tuating the age stratification. The final chapter by O'Donohue, Fisher, and Krasner on "Ethics and the elderly" addresses ethical questions related to the elderly, and to those BOOK REVIEWS 561 who interact with them. Starting from conceptual foundations of ethics, practical issues are addressed underscoring the necessity for both therapists and researchers to acknowledge that science and ethics are intricately inter-related. These considerations in the formulation of rather concrete guidelines for clinical geriatric research and intervention highlight the necessity to respect the elderly's autonomy. Overall the Handbook of clinical gerontology is an excellent and highly valuable text for both researchers and practitioners. This is due to the wide spectrum of different topics that are addressed, to the integration of research perspectives as well as practical concerns, and due to the multidis- ciplinary views presented. The fact that its particular focus is on health- related issues of the elderly qualifies this handbook as being outstanding within gerontological literature. 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